Graduation Year

2024

Document Type

Thesis

Degree

M.S.P.H.

Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Public Health

Major Professor

Deborah Cragun, PhD, MS, CGC

Committee Member

Melissa Racobaldo, MS, CGC

Committee Member

Kathleen Pope, MD, MS, FAAP, FACMG

Keywords

genetic counseling, workplace climate, pediatrics

Abstract

The organizational structures and workflows of pediatric/general genetics clinics exhibit significant variability across institutions. However, there is a notable lack of studies exploring which structural components within pediatric clinics contribute to increased patient volumes, while concurrently upholding genetic counselor work satisfaction and mitigating burnout risks. To address this gap, this multiple case study delves into the operational dynamics of several pediatric genetics clinics located throughout the state of Florida. We employed surveys and interviews to identify shared patterns and distinctions in clinic workflows and structures, subsequently evaluating efficiency and genetic counselor job satisfaction/burnout at each site. This study includes survey data from 17 participants at 8 different clinical sites, 12 of whom also completed follow-up interviews. Descriptive statistics and AI assisted thematic analysis were utilized to identify key themes and patterns across the clinical sites. This study revealed that clinics across the state exhibited a range of models for service delivery, encompassing collaborative approaches involving geneticists, genetic counselors, and genetic counseling assistants, as well as genetic counseling-only clinics. Despite variability in individual clinic workflows, assigned duties, and patient volume, site-level averages for genetic counselor job satisfaction scores were above 3 on a 5-point scale for all GCs and only one GC had a burnout score that met the standard threshold of concern. Key themes identified in interviews suggest that genetic counselors enjoy the variability of indications seen in pediatric clinics and highly value a positive team culture and that these factors were cited as contributing to job satisfaction and may be protecting against burnout. Frustrations with organizational level factors as well as concerns about being burdened with too many additional administrative tasks were reported as negative job aspects. Although challenges of high caseloads were not commonly cited during interviews, the three sites seeing the fewest numbers of patients per GC FTE had the highest job satisfaction, while the two sites with the lowest job satisfaction saw the highest number of patients. Additionally, the three sites with the highest burnout either had a comparatively high patient volume or described the largest number of negative job-related factors in interviews. The results from this study hold significant implications for enhancing the job experience for pediatric genetic counselors and should guide future investigations into the implementation of more streamlined and efficient clinic structures.

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